Case Report

Acute Lithium Intoxication: Properly Directing an Index of Suspicion

Authors: Jonathan W. Thompson, BS, Angela C. Johnson, MD

Abstract

Lithium is known for its efficacy and toxicity. Toxic effects have been characterized even with therapeutic levels. Most physicians will at some point be faced with a patient with altered mental status and no records of his or her history. The differential diagnosis of altered mental status is long, and further lengthens in a patient with a psychiatric history. Since several life-threatening complications of psychotropic medications exist, physicians must be astute with their diagnoses. Lithium toxicity, neuroleptic malignant syndrome, and the serotonin syndrome can present similarly and require rapid recognition. We present a case of lithium toxicity in a patient who presented with altered mental status and a paucity of history information.

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References

1. Philibert I, Friedmann P, Williams WT, for the members of the ACGME Work Group on Resident Duty Hours. New requirements for resident duty hours. JAMA 2002;288:1112-1114.
 
2. Groleau G. Lithium toxicity. Emerg Med North Am 1994;12:511-531.
 
3. Grueneberger EC, Rountree EM, Short EB, et al. Neurotoxicity with therapeutic lithium levels: a case report. J Psychiatr Pract 2009;15:60-63.
 
4. Perlis RH, Ostacher MJ. Lithium and its role in psychiatry. In: Stern TA, Rosenbaum JF, Fava M, et al, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Mosby Elsevier; 2008.
 
5. Delva NJ, Hawken ER. Preventing lithium intoxication. Can Fam Physician 2001;47:1595-1600.
 
6. Brent J, Palmer R. Monoamine oxidase inhibitors and serotonin syndrome. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, PA: Saunders Elsevier; 2007.
 
7. Chen KP, Shen WW, Lu ML. Implication of serum concentration monitoring in patients with lithium intoxication. Psychiatr Clin Neurosci 2004;58:25-29.